Cleveland Clinic Lerner College of Medicine of Case Western Reserve UniversityJewish General Hospital, Montreal, QC, CanadaJohns Hopkins University School of MedicineMcGill University, Montreal, QC, CanadaMcGill University and Jewish General Hospital

Background:

Systemic sclerosis (SSc) often results in disfiguring physical changes that commonly occur in visible and socially relevant areas of the body, including the face, mouth, and hands. The few studies that have investigated body image in SSc have found that patients with more severe SSc reported higher levels of body image dissatisfaction and low appearance self-esteem. These studies, however, used general measures of body image distress developed for use in eating disorders and not validated among patients with acquired disfigurement from disease or injury. Recently, a measure of body image originally developed for patients with burn injury, the Satisfaction with Appearance Scale (SWAP), was validated for use in SSc. The 14-item SWAP, however, which measures social discomfort and dissatisfaction with specific body parts, includes numerous items that are highly redundant and some that are less relevant for patients with SSc. The objective of this study was to develop and cross-validate a brief 6-item version of the SWAP in order to increase SSc-relevancy, reduce item redundancy, and improve feasibility of body image assessment in SSc.

Methods:

Female SSc patients in a developmental sample (Johns Hopkins Scleroderma Center) and a validation sample (Canadian Scleroderma Research Group Registry) completed the 14-item SWAP. Items for the 6-item Brief-SWAP were selected based on theoretical considerations and psychometric data from the developmental sample. In both samples, internal consistency reliability, convergent validity (depressive symptoms, physical and mental health function, pain), and the hypothesized two-factor structure (Perceived Social Impact and Subjective Dissatisfaction) were compared between the Brief-SWAP and SWAP. Confirmatory factor analysis models were conducted with MPlus.

Results:

217 women from the developmental sample and 654 women from the validation sample completed the SWAP. Cronbach's alpha for the Brief-SWAP was 0.82 in both samples compared to 0.90 and 0.91 for the full SWAP. Correlations between the Brief-SWAP and SWAP were 0.94 and 0.95 in the developmental and validation samples. All correlations of the Brief-SWAP and SWAP with measures of convergent validity were substantively equal with no statistically significant differences in either sample. Based on confirmatory factor analysis, model fit for the Brief-SWAP was good in the developmental (c2(4)=9.0, CFI=0.99, TLI=0.99, RMSEA=0.07) and validation samples (c2(4)=19.5, CFI=0.99, TLI=0.99, RMSEA=0.08) and better than for the SWAP in both samples.

Conclusion:

The Brief-SWAP is a reliable and valid measure of body image dissatisfaction and social discomfort related to disfigurement in SSc. Compared to the full 14-item SWAP, the 6-item Brief-SWAP reduced item redundancy, increased relevance to the experience of SSc patients, and demonstrated good psychometric properties including reliability and validity, thus providing a less burdensome and more feasibly administered scale. The results from the current study constitute a significant step towards the improvement of measurement of important body image constructs for individuals with SSc.